“The music is not in the notes, but in the silence between them.”
– Achilles Charles Debussy
Silence is an important part of our everyday lives. Yet, we often don’t consider its critical importance in helping us to reflect on what we’re doing. This is especially important in medicine where we’re so busy sometimes that we forget that what we say and do actually has huge implications on people’s lives.
This is even …
In previous posts, we have reviewed the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as the off-label prescribing of gabapentinoids, for treating anxiety disorders. Anxiety is such a ubiquitous problem that it is not surprising that many other compounds have been used off-label as well. In this posting, we will review some of the common ones: propranolol, mirtazapine, and quetiapine. …
Returning from my week of vacation, I was greeted by the usual stack of mail, faxes, forms to be signed, throwaway journals, and a fully loaded group of in-basket messages that had piled up in the electronic medical record that needed attending to.
One of the pieces of mail was an unsolicited package with a bright red label on it, along with …
We all want to get home as quickly and safely as possible at the end of the day. The other day — as I braked for a red light and turned my right blinker on — I not only looked to see if cars were coming from the left but also checked my rearview mirror.
In a moment of introspection, I suddenly wondered: “Why am I doing that?” What difference would …
“Fashion Is Moving Too Fast, and It’s Killing Creativity,” by Veronique Hyland, talks about burnout in the fashion industry. As a former Fashion Designer turn physician, my curiosity was piqued. If you substituted the word “medicine” for “fashion,” the title would be just as relevant to the medical industry, as it is to the fashion industry. Yes, medicine is moving too fast, and it’s killing creativity and our doctors. Burnout in the fashion industry stems from the need to …
My first transgender patient was a teenager who said although he was born female, he’d protested his gender from the time he could talk. He told a story of being asked, “Well, if you are a boy, where is your penis?” and he pointed to his umbilicus (which was an “outie”). OK, no problem, we have a gender clinic I can refer you to.
When he came back and asked for …
As a profession, we’ve yet to standardize maternity leave and breastfeeding allowances for women. Given the length of medical training (seven-plus post-graduate years), timing (prime reproductive years) and slow increase in the ratio of female to male surgical residents, females choosing to start families during training are particularly afflicted.
We just celebrated my son’s first birthday. I had him during one of the busiest years of my surgical residency, and it’s …
On October 1, 2019, Nevada began allowing individuals to avoid living in late-stage dementia. The new statute recognizes the legitimacy of an advance directive that instructs health care providers to stop hand feeding food and fluid by mouth. Individuals have already been completing such directives in New York and Washington. The Nevada law is the first that explicitly authorizes such instructions.
Growing …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman is evaluated for flushing of the face of 1 year’s duration. These episodes occur two or three times per week and last about 30 minutes. She went through menopause at age 50 and is on estrogen and progesterone hormone therapy. She also experiences episodes of anxiety, …
Dr. Ryme had been retired at least thirty years from medicine when he met me, his last pupil. I was a freshly minted doctor, and he became the first teacher of a new course at my new school called “Life as an Independent Doctor.”
At our first office visit, after telling me his life story, he quizzed me, “And furthermore, Dr. Braun, you’re an attending physician now. You are no longer …
As many of you know, if you’ve read my columns regularly, once a year the whole family escapes from the city, and we travel up to New Hampshire to stay at the lake house that’s been in my wife’s family for over 100 years.
A modest wooden house perched out over the water, situated just right for sunset viewing, for a few …
Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15.
She has had countless disappointing visits with doctors. Some said they couldn’t help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome.
Pinkley has taken opioids a few times after surgeries, but they never helped her underlying pain, she said.
“I hate …
Americans have always loved their medicines and sought them out actively to cure whatever ailed them. Their interest ranged all the way from “staying well” to “feeling better.” Productivity in this hard-charging, pull yourself up by the bootstraps society required activity, and it’s hard to be active when you’re sick.
In the 18th-century in Germany, England, France, and Switzerland, men practicing pharmacy saw their retail operations as the …
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Medical treatment has knocked down tumors in 6-year-old Easton Daniels’ brain, but the drug used also wiped out his immune system.
To bolster his immune function and help keep him healthy, he has visited a hospital for intravenous infusions of immune globulin about every month for the past year and a half.
But in early July, his family was stunned by a letter from Cincinnati Children’s Hospital: “All of Easton’s appointments canceled …
Last year the American Association of Nurse Practitioners announced a $2 million campaign to further expand independent practice, which they already have in 22 states. The relatively new doctorate of nursing (DNP) has led to a confusing scenario where nurses are indeed doctors, just not the kind you think of when you see a white coat. The profession (well, its money-making institutions) has fought hard to keep people confused.
Doctors are …
What is life? It’s the cumulation of the daily processes all wrapped up into one, filling the void of each day. These processes coalesce hour by hour, filled with demands, expectations, current crisis, and bills to pay. Life is a full-contact sport, each hour brimming with all-encompassing activities, expectations, and trivial pursuits. We live every second to its fullest, squeezing every ounce of information and productivity only to repeat it …
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I’m a big proponent of do-it-yourself investing. In the age of index funds, many investors can manage their own investments at very low cost.
And fees you pay to a financial advisor could be used to invest and grow your nest egg.
But that’s not to say that I believe that no one should have a financial advisor. There are many situations where it can be beneficial to hire a financial …
Reality star and meta-celebrity Kim Kardashian West made the rounds on the network news and talk shows last week to promote her new line of shapewear. But she also talked about the recent health scare that was revealed on the latest episode of “Keeping Up with the Kardashians.”
Talking to Savannah Guthrie and Hoda Kotb on Today, …
During one long ago very hot Washington, DC summer, at the suggestion of my parents, I enrolled in a typing course that was given at our elementary school.
This was the summer between sixth and seventh grades, and there were lots of things I would’ve preferred to have been doing, but my dad, who started out in advertising, felt that touch-typing …
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I was in a discussion with a group of patients about how difficult it is for patients to get access to their own medical records. It was initiated after one of my patients was refused copies of her recent hospitalization. There is much confusion out there about who actually owns the record and how it is allowed to be accessed. Most people are aware of HIPAA, the regulation set into …
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